Every month a gastroenterologist from a nearby city has an endoscopy clinic at one of the rural hospitals I work at. For colonoscopy the bowels need to be as empty as possible in order to permit a good evaluation of the mucosa. To that end, patients are asked to take two oral Fleet phosphosoda laxatives on the evening prior to their procedure. The Fleets are remarkably effective at evacuating the bowels and cost only $6.99 each.
Recently a naturopath in the area began offering carrot juice enemas as an alternative to the traditional bowel prep. Carrot juice enemas cost $120. As if that wasn’t bad enough, the damn things don’t work. Instead of inducing the usual 10 or more bowel movements, the carrot juice regimen produces a paltry one or two. One or two BMs aren’t nearly enough to clean out the average person’s colon. Shortly after this new “service” became available, patients started showing up for their colonoscopies with their bowels full of carrot juice and crap. The gastroenterologist would only be able to advance the scope about six inches before running into a solid wall of orange sludge. The procedure would then have to be aborted and rescheduled for a later date. We’d ask people who’d had previous scopes how in the world they figured one or two poops could possibly clear them out when the standard regimen had made them go at least 10 times. “Well, to tell you the truth doc, I was kind of wondering how that was going to work myself… .” Eventually our exasperated consultant began giving his patients free colonoscopic snapshots of the gooey, carroty conglomerate in their bowels so they’d at least have some hard evidence should they attempt to obtain a refund. ¡Madre de Dios! Like the saying goes, a fool and his money are soon parted.
Speaking of fools and their money, another naturopath some of my patients liked to frequent claimed to be able to assess their bio-spiritual chi by closing her eyes and doing this weird hand-fluttering thing around their bodies. After a couple of minutes of humming and swaying she’d come out of her little trance and proclaim that they were dangerously low in xenon or antimatter or whatever. And you thought psychic mass spectrometry didn’t exist! Silly you! A vanishingly small bottle of the life-saving element or mineral their soul so desperately craved would always be available for a mere $75. Cheap like borscht! Oddly enough, the bottles all looked the same to me. I saw a lot of them because after leaving their mystic consultations my patients would invariably rush straight to my office requesting laboratory confirmation of their new diagnosis. “Do I really have a titanium deficiency, doc? Is that bad?” I was often tempted to have the mysterious fluid in the bottles analyzed to see what it really was. Probably carrot juice. A real bar-goon, folks. Ka-ching!
Oh Lordy, here comes the hate mail!
When Your Compassion Runs Out
I was in a toxic mood. Why? Because I’d worked 12 of the last 14 days. Because it was my third graveyard in a row and I was beat. Because the shift had been snakebit from the get-go and I was tired of dealing with crackheads, criminals and bacchants. Sometimes prolonged immersion in the seamy underbelly of a city can be a little soul-destroying. Do it for too long and you start to grow steel behind your eyes. Cripes, who cares what the reasons were? The bottom line is I was fresh out of compassion.
I picked up the next patient’s chart. The triage note indicated she was a 35-year-old shoplifting suspect who had been involved in an altercation with some security guards. Great, I thought, just what I need. A maenad. I knocked on the door and entered the treatment room.
The tall, thin woman curled up on the stretcher had spiky black hair and pinched features. She was sporting an angry purple bruise on her right cheek.
“Are you the doctor?”
“Yes.”
“About time.” She uncoiled her body and pointed at her cheek. “I want this documented. These too.” She rolled up her sleeves to reveal several abrasions on her wrists and forearms.
“What happened?” I asked.
“Some guys jumped me.”
“When did this occur?”
“About six hours ago.”
“Where?”
“Is this really necessary?” she hissed. “I already played 20 Questions with the cops as well as that nosy bitch at the front desk. I don’t feel like doing the same thing with you, too.”
Hoo-boy, was that ever the wrong answer. Now we were going to do this the hard way.
“As a matter of fact, it is necessary,” I replied coldly. “I need to review all the details myself to ensure nothing gets missed. If that doesn’t suit you, you’re welcome to get your medical care somewhere else.”
She shot me a poisonous look, then grumbled, “It happened at the Cost-Savers store downtown.”
“Why did these people attack you?”
“How should I know?”
It was obvious she didn’t want to admit she had been caught shoplifting. I should have just cut her some slack and dropped the subject, but for some reason I was bound and determined to extract a confession. I continued baiting her.
“So a mob of complete strangers tackled you in the middle of a busy department store for no particular reason?”
“They were security guards.”
“What made them pick you?”
“I guess they must have thought I was shoplifting or something.”
“Were you?”
Checkmate. Mongoose victorious.
She hung her head and stared at the floor for a few seconds. When she looked up again, her eyes were glazed with tears.
“Yeah, I was,” she whispered. “I tried to steal a cheap watch. But why’d they have to hurt me so bad? It’s not like I was going to fight them for it. I only took it because I was broke and hungry and I didn’t know what else to do… .”
It was one of the lowest moments of my medical career.
Guilt
“ The only thing that burns in hell is the part of you that won't let go of your life.”
- Louis’ interpretation of a Meister Eckhart concept in Jacob’s Ladder
When I woke up in the ER on-call nap room at 6:00 this morning, Mr. Trapper was sitting at my bedside. I always flinch when that happens.
“You’re not really here,” I said. “You're dead.”
“Well, you don’t have to be so rude about it,” he grumbled.
“I'm sorry,” I apologized. “It's just that sometimes I get tired of reminding you.”
His shoulders slumped, which made me feel guilty. I tried to rationalize: Don't be ridiculous. The dead have no feelings.
“Why do you keep coming back?” I asked.
He pulled a handkerchief out of his translucent pocket and wiped his forehead.
“You know why.”
“Why?”
“I want to live.”
“I'm sorry Mr. Trapper, but much as I'd like to, I can't change what happened.”
He blew his nose and put the handkerchief away.
“It wasn't any fun dying alone on the bathroom floor, doc. They didn't find me for a week. I trusted you. This whole thing is so unfair,” he said quietly.
I looked directly into his hollow eyes.
“I truly am sorry,” I said.
I stepped over his shimmering suitcase, entered the hallway and gently pulled the door closed behind me.
“It's so unfair,” he whispered as it clicked shut.
Time to Go
Recently a pleasant 95-year-old widow named Rose presented to our ER after a brief episode of chest pressure. The discomfort subsided en route to the hospital and never recurred. One of my colleagues examined her and ordered a battery of tests, all of which turned out to be normal. Later that evening he reviewed the results with the patient and her son and recommended she stay in our department overnight for cardiac monitoring. Rose was not interested in any form of aggressive resuscitation, but she didn't mind a brief period of observation. After helping her get settled in for the night, Rose's son departed saying he'd be back at nine in the morning to take his mother home.